Child mortality

Child mortality, also known as under-5 mortality or child death, refers to the death of infants and children under the age of five or between the age of one month to four years depending on the definition. A child's death is emotionally and physically hard on the parents. Many deaths in the majority of the world go unreported since many poor families cannot afford to register their babies in the government registry.

The same causes and preventative measures that apply to infant mortality (i.e. for children younger than one year old) also apply to understanding child mortality.

Reduction of child mortality is the fourth of the United Nations' Millennium Development Goals. Rapid progress towards the Millennium Development Goals has resulted in a significant decline in preventable child deaths since 1990, with the global under-5 mortality rate declining by nearly half over this time period. While in 1990, 12.7 million children under age five died, in 2013 that number fell to 6.3 million children.^[1] However, despite advances, at the current pace the world will not meet the MDG target until 2026.

Globally in 2013 3.7 million children aged one month to 4 years of age died, down from 7.6 million in 1990.^[2] About half of child deaths occur in Sub-Saharan Africa. Reduction of child mortality is the fourth of the United Nations' Millennium Development Goals.

Causes

The leading causes of death of children under five include:

• Diarrhea
• Malaria
• Malnutrition
• Pneumonia
• Preterm birth conditions

Pneumonia, diarrhea and malaria together are the cause of 3 out of every 10 child deaths before the age of 5 and nearly half of under-five deaths globally are attributable to undernutrition.^[3]

Prevention and child survival

Child survival is a field of public health concerned with reducing child mortality. Child survival interventions are designed to address the most common causes of child deaths that occur, which include diarrhea, pneumonia, malaria, and neonatal conditions. Of the portion of children under the age of 5 alone, an estimated 9.2 million children die each year mostly from such preventable causes. According to an estimate by UNICEF in 2008, one million child deaths could be prevented annually at a cost of $US 1 billion per year (an average of $US 1000 for each child).^[4]

The child survival strategies and interventions are in line with the fourth Millennium Development Goal which focused on reducing child mortality by 2/3 of children under five before the year 2015. Many countries are now devoted to the child survival interventions as a way of reducing the child mortality. In ACP countries European commission (EC) is intervening to with funds and technical capacity to assist the ACP countries reinforce their immunisation services through a project called EU-PRIME which was a baby of cotonou agreement. The overall aim of the project is to reduce the impact and incidence of vaccines preventable diseases (VPDs) in countries of intervention.

Low-cost interventions

Two-thirds of child deaths are preventable.^[5] Most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices,^[6] and oral rehydration therapy.^[7] Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make the supply of critical services more available to the poor and increasing local accountability of health systems are policy interventions that have allowed health systems to improve equity and reduce mortality.^[8]

In developing countries, child mortality rates related to respiratory and diarrheal diseases can be reduced by introducing simple behavioral changes, such as handwashing with soap. This simple action can reduce the rate of mortality from these diseases by almost 50 per cent.^[9]

Proven, cost-effective interventions can save the lives of millions of children per year. Immunization interventions still do not reach 30 million children, despite success in immunizations in reducing polio, tetanus, and measles. Measles and tetanus still kill more than 1 million children under 5 each year. Vitamin A supplementation costs only $0.02 cents for each capsule and given 2-3 times a year will prevent blindness and death. Although vitamin A supplementation saved an estimated 2.3 million lives between 1999 and 2004, only half of young children in poor countries receive these treatments. Between 250,000 and 500,000 children become blind every year, with 70 percent of them dying within 12 months. Oral rehydration therapy (ORT) has helped to reduce diarrhea deaths by half, saving an estimated 1 million lives annually; yet more than 2 million children still die from diarrhea-related causes each year.

Essential newborn care - including immunizing mothers against tetanus, ensuring clean delivery practices in a hygienic birthing environment, drying and wrapping the baby immediately after birth, providing necessary warmth, and promoting immediate and continued breastfeeding, immunization, and treatment of infections with antibiotics - could save the lives of 3 million newborns annually. Improved sanitation and access to clean drinking water can reduce childhood infections and diarrhea. Over 40 percent of the world's population does not have access to basic sanitation, and more than one billion people use unsafe sources of drinking water.

The Lancet Child Survival Series

The British medical journal The Lancet has published a widely quoted series of five articles outlining the current child survival situation, include challenges and feasible solutions, commonly referred to as "The Lancet Child Survival Series". The series outlines a number of child survival interventions which have been scientifically proven to reduce mortality, include oral rehydration therapy, sleeping under insecticide-treated mosquito nets, vitamin A supplementation, and community-based antibiotic treatment for pneumonia. Agencies promoting and implementing child survival activities worldwide include UNICEF and non-governmental organizations; major child survival donors worldwide include the World Bank, the British Government's Department for International Development, the Canadian International Development Agency and the United States Agency for International Development. In the United States, most non-governmental child survival agencies belong to the CORE Group, a coalition working, through collaborative action, to save the lives of young children in the world's poorest countries.

Epidemiology

The under-5 mortality rate is the number of children who die by the age of five, per thousand live births per year. In 2013, the world average was 46 (4.6%), down from 90 (9.0%) in 1990.^[10] The average was 6 in developed countries and 50 in developing countries, including 92 in Sub-Saharan Africa. The highest rate in the world was 167, in Angola.^[11] Likewise, there are disparities between wealthy and poor households in developing countries. According to a Save the Children paper, children from the poorest households in India are three times more likely to die before their fifth birthday than those from the richest households.^[12] However, there are also limitations in calculating an accurate rate in developing countries, especially in rural areas. An ethnographic study in Pacatuba, Brazil, found that the under-5 mortality rate only accounted for 44.4% of the actual deaths that occurred in the community. High travel costs, lost labor, and a withdrawal of socio-economic benefits are factors as to why deaths may not be reported to government vital statistics agencies within a country.^[13]

Sub-Saharan Africa, the region with the highest rate of child mortality, lowered its under-five mortality rate by 48% since 1990. "All 12 countries with an under-five mortality rate of 100 or more deaths per 1,000 live births are in sub-Saharan Africa, and 10 of these are in West and Central Africa. On average, 1 out of every 11 children born in sub-Saharan Africa dies before age 5. This is nearly 15 times the average."^[1]

Every year nearly 10 million children under age five die, mostly from preventable and treatable diseases. Nearly 27,000 children die every day as a result of diseases like pneumonia, diarrhea and complications during childbirth. Malnutrition is an underlying contributor in over half of these deaths. Similarly, 4 million newborns die in the first 4 weeks of life (40 percent of under-5 deaths). 98 percent of under-5 deaths occur across only 42 developing countries.

Global trends

In a TED presentation shown here, Hans Rosling presented the distribution and change in the child survival rate of various nations over the course of a few decades along with other factors such as fertility rate and income distribution; the change in distribution shows a strong correlation between child survival and income distribution as well as fertility rate where increasing child survival allows the average income to increase as well as the average fertility rate to decrease.^[14]

See also

• List of countries by infant mortality rate
• List of water supply and sanitation by country
• Waterborne diseases
• Fecal-oral route

References

External links

• Child mortality estimates for all countries - website by UNICEF
• Childsurvival page